Development of Antimicrobial Stewardship Programmes in Low and Middle-Income Countries: A Mixed-Methods Study in Nigerian Hospitals
Development of Antimicrobial Stewardship Programmes in Low and Middle-Income Countries: A Mixed-Methods Study in Nigerian Hospitals
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DOI：
10.3390/antibiotics9040204
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发表时间：
2020-04-01
影响因子：
4.8
通讯作者：
Smith, Felicity J.
中科院分区：
文献类型：
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作者：
Kpokiri, Eneyi E.;Taylor, David G.;Smith, Felicity J.
抗微生物药物耐药性（AMR）是当今全球卫生面临的一个主要关切，对传染病负担高得多的发展中国家的影响最大。抗生素的不当处方和使用是导致抗生素耐药性增加的因素之一。实施抗菌素管理规划（AMS），以优化抗菌素的使用并促进行为改变。辅助医疗辅助方案已被广泛采用，并在许多高收入环境中被证明可改善抗生素的使用。然而，控制抗微生物药物耐药性的战略尚未在低资源环境中成功实施。世界卫生组织（世卫组织）最近为低收入和中等收入国家的辅助医疗服务制定的工具包认识到当地情况在制定辅助医疗服务方案中的重要性。本研究采用了一种自下而上的方法来确定中低收入环境中抗微生物药物处方实践的重要当地决定因素，为当地辅助医疗服务规划的制定提供信息。对处方做法的分析和对处方者的访谈强调了辅助医疗辅助方案的优先事项，其中包括提高对抗生素耐药性的认识，制定和维持抗生素使用指南，监测和监督抗生素使用，确保低成本仿制药的质量，以及改进实验室服务。已建立的行为改变理论模型的应用指导了AMS具体建议的发展。最后，在与利益相关者协商后，探讨了该计划的可行性及其实施战略。该项目提供了一个设计实例，并建议实施辅助医疗服务计划，以改善中低收入环境中医院的抗生素使用情况。
Antimicrobial resistance (AMR) is a major concern facing global health today, with the greatest impact in developing countries where the burden of infectious diseases is much higher. The inappropriate prescribing and use of antibiotics are contributory factors to increasing antibiotic resistance. Antimicrobial stewardship programmes (AMS) are implemented to optimise use and promote behavioural change in the use of antimicrobials. AMS programmes have been widely employed and proven to improve antibiotic use in many high-income settings. However, strategies to contain antimicrobial resistance have yet to be successfully implemented in low-resource settings. A recent toolkit for AMS in low- and middle-income countries by the World Health Organisation (WHO) recognizes the importance of local context in the development of AMS programmes. This study employed a bottom-up approach to identify important local determinants of antimicrobial prescribing practices in a low-middle income setting, to inform the development of a local AMS programme. Analysis of prescribing practices and interviews with prescribers highlighted priorities for AMS, which include increasing awareness of antibiotic resistance, development and maintenance of guidelines for antibiotic use, monitoring and surveillance of antibiotic use, ensuring the quality of low-cost generic medicines, and improved laboratory services. The application of an established theoretical model for behaviour change guided the development of specific proposals for AMS. Finally, in a consultation with stakeholders, the feasibility of the plan was explored along with strategies for its implementation. This project provides an example of the design, and proposal for implementation of an AMS plan to improve antibiotic use in hospitals in low-middle income settings.